Provider Demographics
NPI:1568400232
Name:FLORIDA PHYSICIANS MEDICAL GROUP
Entity Type:Organization
Organization Name:FLORIDA PHYSICIANS MEDICAL GROUP
Other - Org Name:HIGHLANDS SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STILTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-200-2700
Mailing Address - Street 1:4409 SUN N LAKE BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2170
Mailing Address - Country:US
Mailing Address - Phone:863-385-1900
Mailing Address - Fax:863-385-9229
Practice Address - Street 1:4409 SUN N LAKE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2170
Practice Address - Country:US
Practice Address - Phone:863-385-1900
Practice Address - Fax:863-385-9229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA2516OtherRAILROAD MEDICARE
FLK4428Medicare PIN